Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $185 in 2025. MIPP is for some groups who are either not eligible for -- or who are not yet enrolled in-- the Medicare Savings Program (MSP), which is the main program that pays the Medicare Part B premium for low-income people. Some people are not eligible for an MSP even though they have full Medicaid with no spend down. This is because their income is higher than MSP income limits, but they are still eligible for Medicaid in a special Medicaid eligibility category -- discussed below. MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP QMB level (138% of the Federal Poverty Level (FPL).
Even if their income is under the QI-1 MSP level (186% FPL), they may not enroll in QI-1 MSP because one cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program.
In this article:
The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7). There are generally four groups of dual-eligible consumers that are eligible for MIPP:
MBI-WPD is a program for people under 65 who are disabled and working. They have two big financial advantages:
They can be eligible for Medicaid at much higher income limits. The 2024 MBI WPD net income limit is $3,138 per month (250% FPL), compared to the regular disabled/aged/blind (DAB) Medicaid income limit of $1,732 per month (138% FPL). (Both of those limits are net income, after applicable income disregards). See this article for current income limits.
Earned income has a special "disregard" as a work incentive. Subtract $65 from monthly gross earned income, then deduct half of the remainder. So less than half of gross monthly income counts against the higher MBI-WPD income level. See links in this article for a more detailed explanation.
Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed. See MAXIMUS, NY Health Insurance Programs Training, Frequently Asked Questions- 2nd question under MEDICARE SAVINGS PROGRAM HEADING -
"What is the advantage of a MIPP eligibility as opposed to an MSP?"
"The main scenarios are clients in the MBI-WPD program and those with full Medicaid under MAGI-like budgeting who have income above the SLMB level.** Since clients in these scenarios cannot have full Medicaid and QI, they are given full Medicaid coverage and MIPP reimbursement. Also, there are clients who need a partial MIPP to reimburse them up to the MA level. Additionally, LDSS staff will see recipients being referred from NYSOH to the district who are in receipt of MIPP. These clients may be eligible for MSP going forward at the district but would be receiving MIPP at the time of referral.
Additionally, LDSS staff will see recipients who are being referred from NYSOH to the District who are in receipt of MIPP. These clients may be eligible for MSP going forward at District but would be receiving MIPP at the time of referral."
**NYLAG note: This has not been updated since SLIMB was eliminated effective Jan. 2023. To be current, replace "SLMB" with "QMB" in that sentence.
NYLAG EXAMPLE: Sam is age 50 and has Medicare and MBI-WPD. They gets $2000/mo gross from Social Security Disability and also make $1000/month through work activity.
$ 467.50 -- EARNED INCOME - Because Sam is disabled, the DAB earned income disregard applies:
$1,000 - $65 = $935. Countable earned income is 1/2 of $935 = $467.50
+ $2000.00 -- UNEARNED INCOME from Social Security Disability - without subtracting the Part B premium.
= $2,447.50 --TOTAL income. (after deducting $20 disregard) This is above the QMB limit of $1,732 (2024) but they can still qualify for MIPP because eligible for MBI-WPD.
Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.”
MAGI-like consumers can be enrolled in either MSP or MIPP, depending on whether their income is higher or lower than 138% of the FPL. If their income is under 138% FPL, they are eligible for MSP as a QMB. If income is above 138% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4).
Disabled Adult Child (DAC):
Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this article.
Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP.
See also 95-ADM-11: Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8):
"Individuals who are certified as DAC MA eligible and who are in receipt of Medicare Part B are eligible to have MA pay the appropriate Medicare premium on their behalf through the Buy-In system."
Pickle & 1619B:
Similarly, consumers with full Medicaid under the Pickle Amendment or 1619B are also eligible to have their premiums reimbursed under the buy-in program. See page 80 of the Medicaid Reference Guide (Categorical Factors).
When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, the procedure BEFORE COVID was to transfer the Medicaid case ifrom NYSOH to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting AND to authorize MSP.
Since Jan. 1, 2023, NYSOH enrolls the consumer directly into the QMB Medicare Savings Program. NYSOH does the MSP enrollment regardless of whether the case continues to be managed by NYSOH, or is transferred to the LDSS/HRA (See GIS 23 MA/10 - Update to Medicare Premium Payment Process for Individuals Referred From NY State of Health to a Local Department of Social Services May 26, 2023). NYSOH continues to manage Medicaid for many new Dual Eligibles (new to Medicare) during the "unwinding" of the Public Health Emergency. Eventually most of these cases will be transferred to LDSS. But int the meantime, NYSOH enrolls them in MSP.
See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of the process that existed before 2023. That directive also clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan.
MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences:
MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as:
Special Enrollment Period to enroll in Medicare Part B outside of the usual time periods
There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7).
Either the state or the LDSS is responsible for screening & distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V).
If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy.
If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP.
If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov.
If Medicaid case is with other local districts in NYS, call your local county DSS.
See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP.
Once enrolled, it make take a few months for payments to begin.
Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for.